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Date: October 14,2026
Aetna, Occupational Therapy, and Direct Access
On June 17, 2025, Aetna allowed direct access for physical therapy (PT) services. Aetna removed the requirement of a physician order for PT. Aetna also removed the requirement that a physician must sign the PT plan of care.
Unfortunately, Aetna did not do the same for occupational therapy (OT) in June 2025. So, in 2026, what does Aetna require for outpatient OT services?
Effective
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How does this apply to direct access rules in California? If they don’t require a referral then they can come via direct access in California for 12 visits or 45 days, whichever comes sooner. If we have a signed plan of care that is sufficient to satisfy the referral requirement and they can continue treating. However, if Aetna is no longer requiring a referral or signed plan of care then do direct access rules apply if we don’t receive the plan of care signed or does Aetna rules superceded and we don’t need either and can treat as long as it is medically necessary?
You always follow the rule that is most restrictive. In your example, after 12 visits or 45 days, whichever comes sooner, you would then need a physician referral per your practice act.
could you give us a summary of which insurance providers do allow for direct access for OT? I often see this in writing for PT, but it is harder to find information for OT’s. My undrestanding also has been that the plan of care written with a direct access patient is only good for 30 days and after the initial 30 days, the patient is required to have a physical order or a signed plan of care. Can you confirm these details? thank you!
Since there are about 1000 insurers in the USA, that is not something I can provide to you. If the insurer allows direct access and your state has direct access, you must follow the one that is most restrictive.